MANAGEMENT OF DELIVERY

Module 11 : Management of Delivery Learning outcomes: To understand and demonstrate appropriate knowledge, skills and attitudes relating to management of delivery. Knowledge criteria Clinical competency Professional skills and attitudes Training support Evidence/assessment Normal vaginal delivery Operative vaginal delivery Complex vaginal delivery Retained placenta Sterilisation procedures Sterilisation procedures General anaesthesia Regional anaesthesia The unconscious patient Normal delivery Vacuum extraction without rotation Forceps delivery without rotation Shoulder dystocia Retained placenta Recognition of malpresentation Caesarean section with sterilisation Cord prolapse Uncomplicated caesarean section Repeat caesarean section Acute emergency caesarean section Rotational assisted delivery Vaginal delivery of twins Vaginal breech delivery Make appropriate decisions in the choice of delivery in partnership with the mother and respect the views of other healthcare workers (midwives) Be aware of emotional implications for woman, family and staff Acknowledge and respect cultural diversity Respect individual dignity and privacy Respect confidentiality Demonstrate the ability to communicate clearly and effectively at times of stress Shoulder dystocia drill Perinatal mortality and morbidity meetings StratOG.net: Management of Labour and Delivery e-tutorials MOET/ALSO course Local protocols Useful websites: www.nice.org.uk www.rcog.org.uk www.sign.ac.uk www.show.scot.nhs.uk/ spcerh Audit project SOE MRCOG Part 2 Logbook PROMPT COURSE ALSO course OSATS: Operative vaginal delivery Caesarean section Manual removal of Placenta Delivery with fetal malpresentation Previously undiagnosed breech Caesarean section with placenta praevia Uterine rupture Vaginal breech delivery including second twin Show ability to prioritise workload Demonstrate team management and show leadership according to year of training Be realistic recognition of own competence level and have selfawareness to call for help when necessary Demonstrate the use of appropriate protocols and guidelines Module 11 Management of Delivery Curriculum

Appendix to Curriculum Module 11: details of knowledge criteria Operative/complex vaginal delivery: Malpresentation (brow, face, shoulder, variable lie) Malposition Manual rotation of the fetal head Outlet forceps/ventouse Mid-cavity forceps/ventouse Rotational forceps/ventouse Pelvic floor anatomy Episiotomy Perineal trauma and repair Assisted breech delivery Breech extraction Twin delivery High order multiple births Shoulder dystocia Caesarean section: Indications and complications Routine Repeat Acute emergency Sterilisation procedures Anaesthesia: General Regional Induction agents Inhalation agents Prophylactic measures Complications The unconscious patient Resuscitation Intensive care Module 11 Management of Delivery Curriculum

Fill in as a record of experience. Module 11 : Management of Delivery Skills Competence level Basic training Intermediate training Advanced training Not required Observation Direct supervision Independent practice Signature of trainer Signature of trainer Signature of trainer Normal delivery Shoulder dystocia Ventouse extraction without rotation Uncomplicated acute/elective caesarean section Repeat caesarean section (two or more previous sections) Retained placenta Cord prolapse Forceps delivery without rotation Caesarean section with sterilisation Vaginal delivery of twins Preterm (< 28 weeks) caesarean section Rotational assisted ventouse delivery Complex emergency caesarean section Caesarean section for placenta praevia Caesarean section after failed instrumental delivery Caesarean section at full dilation Recognise undiagnosed breech Module 11 Management of Delivery Logbook

Module 11 : Management of Delivery Fill in as a record of experience. Skills Competence level Basic training Intermediate training Advanced training Not required Observation Direct supervision Independent practice Signature of trainer Signature of trainer Signature of trainer Vaginal breech delivery Delivery with fetal malpresention Uterine rupture Training courses or sessions Title Signature of educational supervisor Shoulder dystocia drill Authorisation of signatures (to be completed by the clinical trainers) Name of clinical trainer (please print) o o o o o o Signature of clinical trainer Module 11 Management of Delivery Logbook

OSATS Record all formal assessments until trainee passess. Record date of satisfactory assessment. Operative vaginal delivery Signature Signature Signature Signature Signature Fetal blood sampling Signature Signature Signature Signature Signature Caesarean section Signature Signature Signature Signature Signature Manual removal of placenta Signature Signature Signature Signature Signature COMPLETION OF MODULE 11 I confirm that all components of the module have been successfully completed: Name of educational supervisor Signature of educational supervisor o Module 11 Management of Delivery Logbook

OPERATIVE VAGINAL DELIVERY Trainee Name: StR Year: : Assessor Name: Clinical details of complexity/ difficulty of case Instrument used: Post: Items under observation: opening Ensure patient and accompanying partner understand procedure Appropriate preoperative preparation: adequate analgesia, bladder empty Examination: engagement, position, station, caput, moulding, descent with contraction, pelvic size and shape Decision making: choice of instrument Correct assembly and checking of equipment Correct application of instrument Appropriate direction, force and timing of pull. Ensures head descends with traction Appropriate alteration of traction with delivery of head Protects perineum and assess need for episiotomy Performed Needs independently help PLEASE TICK RELEVANT BOX Checks for cord. Correct delivery of shoulders and body Delivery of placenta and membranes Checks for uterine laxity and vaginal trauma Estimated Blood Loss and manages blood loss Appropriate use of team Awareness of maternal and fetal wellbeing throughouts Comments: Examples of minimum levels of complexity for each stage of training Basic Training Uncomplicated. Non rotational Intermediate Training Rotational ventouse Advanced Rotational forceps/ventouse in theatre Both sides of this form to be completed and signed

GENERIC TECHNICAL SKILLS ASSESSMENT Assessor, please ring the candidate s performance for each of the following factors: Respect for tissue Time, motion and flow of operation and forward planning Knowledge and handling of instruments Suturing and knotting skills as appropriate for the procedure Technical use of assistants Relations with patient and the surgical team Insight/attitude Documentation of procedures Frequently used unnecessary force on tissue or caused damage by inappropriate use of Many unnecessary moves. Frequently stopped operating or needed to discuss next move. Lack of knowledge of Placed sutures inaccurately or tied knots insecurely and lacked attention to safety. Consistently placed assistants poorly or failed to use assistants. Communicated poorly or frequently showed lack of awareness of the needs of the patient and/or the professional team. Poor understanding of areas of Limited documentation, poorly written. Careful handling of tissue but occasionally causes inadvertent Makes reasonable progress but some unnecessary moves. Sound knowledge of operation but slightly disjointed at times. Competent use of instruments but occasionally awkward or tentative. Knotting and suturing usually reliable but sometimes awkward. Appropriate use of assistant most of the time. Reasonable communication and awareness of the needs of the patient and/or of the professional team. Some understanding of areas of Adequate documentation but with some omissions or areas that need elaborating. Consistently handled tissues appropriately with minimal Economy of movement and maximum efficiency. Obviously planned course of operation with effortless flow from one move to the next. Obvious familiarity with Consistently placed sutures accurately with appropriate and secure knots and with proper attention to safety. Strategically used assistants to the best advantage at all times. Consistently communicated and acted with awareness of the needs of the patient and/or of the professional team. Fully understands areas of Comprehensive legible documentation, indicating findings, procedure and postoperative management. Based on the checklist and the Generic Technical Skills Assessment, Dr has achieved/failed* to achieve the OSAT competency Needs further help with: Competent to perform the entire * procedure without the need for * supervision (trainer) (trainee) Delete where applicable, and date and sign the relevant box

CAESAREAN SECTION Trainee Name: StR Year: : Assessor Name: Post: Clinical details of complexity/ difficulty of case Performed independently Needs help Item under observation Appropriate skin incision (e.g. length, position) Safe entry of peritoneal cavity Careful management of bladder Appropriate uterine incision (e.g. length, position) Safe and systematic delivery of baby Appropriate delivery of placenta Check uterine cavity (e.g. intact, empty, configuration) Safe securing of uterine angles Check for ovarian pathology Appropriate closure of rectus sheath Attention to haemostasis Neatness of skin closure Comments: PLEASE TICK RELEVANT BOX Trainees are expected to do caesarean section for increasingly more complicated cases e.g. Transverse lie as they progress in training.

MANUAL REMOVAL OF PLACENTA Trainee Name: StR Year: : Assessor Name: Clinical details of complexity/ difficulty of case Post: Item under observation: Ensures adequate analgesia Ensures empty bladder/catheterises Performs procedure with appropriate abdominal countertraction Ensures cavity empty Ensures adequate uterine contraction Checks blood loss and haemostasis Checks for trauma Comments: Performed Needs independently help PLEASE TICK RELEVANT BOX Both sides of this form to be completed and signed

FETAL BLOOD SAMPLING Trainee Name: StR Year: : Assessor Name: Clinical details of complexity/ difficulty of case Post: Preparation of the patient: Ensures patient and partner understand procedure Establishes level of pain relief and acts appropriately Supervises positioning of patient corrects as required Appropriate use of assistants Assembles/positions equipment Demonstrates knowledge of equipment and can troubleshoot problems Operative procedure Assesses dilatation and position of cervix Obtains clear, well-lit view of fetal scalp Collects uncontaminated good-sized sample without air bubbles Applies pressure to scalp wound Has strategies to overcome technical difficulties such as high head, inadequate bleeding Correct interpretation of results Performed Needs Not independently help Applicable PLEASE TICK RELEVANT BOX Both sides of this form to be completed and signed